Bottom Line:
Risk groups included presence/absence of hypertension, diabetes, cardiovascular complications, history of stroke, history of cancer, and age/activity level (elderly/inactive or young/active).At each time point, more than three quarters of physicians responded that results from the TREAT study, in patients not on dialysis, have influenced their use of erythropoiesis-stimulating agents in patients on haemodialysis.A similar disparity was noted at T2.

Purpose: Data from an ongoing European pharmacoepidemiological study (MONITOR-CKD5) were used to examine congruence between physician-reported risk-based individualisation of target haemoglobin (Hb) and the actual Hb targets set by these physicians for their patients, as well as actual Hb levels in their patients.

Methods: Physician investigators participating in the study completed a questionnaire about their anaemia practice patterns and attitudes post-TREAT at the start of the study (T1) and in summer 2013 (T2). These data were compared with the Hb targets identified at baseline for actual patients (n = 1197) enrolled in the study. Risk groups included presence/absence of hypertension, diabetes, cardiovascular complications, history of stroke, history of cancer, and age/activity level (elderly/inactive or young/active).

Results: At each time point, more than three quarters of physicians responded that results from the TREAT study, in patients not on dialysis, have influenced their use of erythropoiesis-stimulating agents in patients on haemodialysis. At T1, there was a clear difference in physician-reported (theoretical) target Hb levels for patients across the different risk groups, but there was no difference in patients' actual Hb levels across the risk groups. A similar disparity was noted at T2.

Conclusions: Physicians' theoretical attitudes to anaemia management in patients on haemodialysis appear to have been influenced by the results of the TREAT study, which involved patients not on dialysis. Physicians claim to use risk-based target Hb levels to guide renal anaemia care. However, there is discrepancy between these declared risk-based target Hb levels and actual target Hb levels for patients with variable risk factors.

Mentions:
The majority of patients (82 %) were already receiving ESA therapy on study entry. Mean (SD) weekly dose of biosimilar epoetin alfa was 7532 (5342) IU, and mean (SD) Hb at baseline was 11.15 (1.17) g/dL. Dose of biosimilar epoetin alfa and Hb level over 18 months by region are illustrated in Fig. 6. Across all visits, patients in EE had significantly lower doses than patients in WE controlling for age and comorbidities (β = −0.2834, p < 0.0001; note that dose has been logarithmised, so the estimate represents percentage difference); and, while both EE and WE doses varied significantly over time (β = −0.0127, p < 0.0001 and β = −0.0034, p = 0.0370, respectively), the difference in trajectory was significantly different (β = −0.0093, p = 0.0042) with EE having a clear decline (from 6300 to 5500 IU/wk), while WE remained between 7900 and 8300 IU/wk but with month-to-month variability. Hb was also significantly different between regions controlling for age and number of comorbidities (β = −0.2114 g/dL, p < 0.0001) and with significantly different trajectories (β = −0.0165, p = 0.0002): EE had small but significant Hb decline (β = −0.0166, p < 0.0001), while WE had no significant change (β = −0.0001, p = 0.9618). At enrolment, 25 % of patients had experienced a prior thromboembolic event (TEE). During follow-up, 9.4 % of patients had a TEE, of which the majority were shunt thrombosis.Fig. 6

Mentions:
The majority of patients (82 %) were already receiving ESA therapy on study entry. Mean (SD) weekly dose of biosimilar epoetin alfa was 7532 (5342) IU, and mean (SD) Hb at baseline was 11.15 (1.17) g/dL. Dose of biosimilar epoetin alfa and Hb level over 18 months by region are illustrated in Fig. 6. Across all visits, patients in EE had significantly lower doses than patients in WE controlling for age and comorbidities (β = −0.2834, p < 0.0001; note that dose has been logarithmised, so the estimate represents percentage difference); and, while both EE and WE doses varied significantly over time (β = −0.0127, p < 0.0001 and β = −0.0034, p = 0.0370, respectively), the difference in trajectory was significantly different (β = −0.0093, p = 0.0042) with EE having a clear decline (from 6300 to 5500 IU/wk), while WE remained between 7900 and 8300 IU/wk but with month-to-month variability. Hb was also significantly different between regions controlling for age and number of comorbidities (β = −0.2114 g/dL, p < 0.0001) and with significantly different trajectories (β = −0.0165, p = 0.0002): EE had small but significant Hb decline (β = −0.0166, p < 0.0001), while WE had no significant change (β = −0.0001, p = 0.9618). At enrolment, 25 % of patients had experienced a prior thromboembolic event (TEE). During follow-up, 9.4 % of patients had a TEE, of which the majority were shunt thrombosis.Fig. 6

Bottom Line:
Risk groups included presence/absence of hypertension, diabetes, cardiovascular complications, history of stroke, history of cancer, and age/activity level (elderly/inactive or young/active).At each time point, more than three quarters of physicians responded that results from the TREAT study, in patients not on dialysis, have influenced their use of erythropoiesis-stimulating agents in patients on haemodialysis.A similar disparity was noted at T2.

Purpose: Data from an ongoing European pharmacoepidemiological study (MONITOR-CKD5) were used to examine congruence between physician-reported risk-based individualisation of target haemoglobin (Hb) and the actual Hb targets set by these physicians for their patients, as well as actual Hb levels in their patients.

Methods: Physician investigators participating in the study completed a questionnaire about their anaemia practice patterns and attitudes post-TREAT at the start of the study (T1) and in summer 2013 (T2). These data were compared with the Hb targets identified at baseline for actual patients (n = 1197) enrolled in the study. Risk groups included presence/absence of hypertension, diabetes, cardiovascular complications, history of stroke, history of cancer, and age/activity level (elderly/inactive or young/active).

Results: At each time point, more than three quarters of physicians responded that results from the TREAT study, in patients not on dialysis, have influenced their use of erythropoiesis-stimulating agents in patients on haemodialysis. At T1, there was a clear difference in physician-reported (theoretical) target Hb levels for patients across the different risk groups, but there was no difference in patients' actual Hb levels across the risk groups. A similar disparity was noted at T2.

Conclusions: Physicians' theoretical attitudes to anaemia management in patients on haemodialysis appear to have been influenced by the results of the TREAT study, which involved patients not on dialysis. Physicians claim to use risk-based target Hb levels to guide renal anaemia care. However, there is discrepancy between these declared risk-based target Hb levels and actual target Hb levels for patients with variable risk factors.